He said that, in the week prior to Kyla's death, Puhle had been asked by her husband to arrange a medical appointment for their daughter.

"She went to work intending to make the appointment but she did not, having been distracted at work," he said.

"She later told Mr Puhle she had made the appointment, but it had to be cancelled because the doctor was ill.

"Thereafter it was her intention to take her daughter to an alternative medical practice, not their GP, where an appointment was not necessary."

Mr Boucaut said Kyla died before that medical visit could take place.

"Had the (original) appointment been made and kept, there obviously would have been a chance not just the malnourishment issues but also the dehydration could have been treated," he said.

"We know that didn't occur."

Mr Boucaut said the Puhle family had spent many years on waiting lists for disabled health care assistance.

"It's very difficult, short of abandoning your child, to get help," he said.

Mr Boucaut said psychological reports showed Puhle had become "disillusioned" with the medical system and avoided going to doctors even for herself.

He said the Puhle "family unit" revolved about Harry, who "demanded results".

"She has suffered enormously, she has lost her husband and she loved her husband, notwithstanding him being a difficult person," he said.

"She has lost her daughter, whom she loved and devoted a great part of her life to her needs."

He asked the court to suspend his client's inevitable sentence.

"She has to be seen, in my submission, as someone who is not going to offend," he said.

"She now has to suffer the label of being somebody who has, in effect, brought about her daughter's death - which is an incredibly difficult thing for her to cope with."

Deputy Director of Public Prosecutions Sandi McDonald, SC, said Puhle should serve an immediate custodial term.

She said that, in the week prior to her death, Kyla was left alone and unsupervised in the house because her parents had removed her from daytime respite care.

"The last months of her life, her parents took her out of the care of those who were helping keep her alive," she said.

"Puhle stopped Kyla having access to anyone in the world except her and Mr Puhle.

"(Kyla's) death was pretty much inevitable."

Ms McDonald said that, while she could not help but feel sympathy for Puhle, it would be inappropriate to suspend the sentence.

"It wasn't a momentary lapse, it was neglect that continued over an extended period of time," she said.

"(Kyla) was literally starved to death."

In sentencing today, Justice Sulan said Puhle had served as her daughter's primary carer, often going it alone because doctors had concluded they could "do little" for the girl.

While refusing to pass judgment on state disability services, he noted Kyla's combination of problems did not qualify her as a "priority case" when her parents sought to have her taken into permanent care.

Justice Sulan said a post-mortem examination showed Kyla had died from a chest infection commonly suffered by severely disabled people.

He referred to expert medical evidence that such an infection was hard to detect - but said that provided no excuse for Puhle's lack of reaction to Kyla's emaciated state.

"A person in your position should have been aware she was severely malnourished and had lost a considerable amount of weight," he said.

Justice Sulan said Puhle's decision to leave her daughter at home "in a beanbag" was made out of the mistaken belief that was a better option than being at day care.

He said Puhle genuinely believed she was acting in Kyla's best interests, and addressing her ongoing problem with pressure sores.

He said mental health experts had diagnosed a form of "psychological denial" in which Puhle focused on "the light at the end of the tunnel" rather than seeking help for her difficulties.

"For all but a few weeks of Kyla's 27 years, you devoted all your time and energy to her welfare," he said.

"You believed you were acting in her best interests, and that was your genuine belief.

"You have suffered enormously over the years and confronted adversity in a way many others could not have ... sadly, it seems you did not seek assistance for yourself."

Justice Sulan imposed a five-year jail term with a 2 ½ year non-parole period, saying the crime of manslaughter was too serious for anything beside jail.

However, he said good reason existed to suspend that sentence and release Puhle on a three-year, $1000 bond.

Puhle, who appeared to be fighting back tears, thanked Justice Sulan as she was released.

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